Success of de novo reimplantation of the artificial genitourinary sphincter

Purpose: We evaluate our experience with de novo reimplantation of the arti ficial genitourinary sphincter with a particular emphasis on mechanical and nonmechanical failure rates. De novo reimplantation is defined as implanta tion of an artificial sphincter following removal of a previously placed sp hincter for erosion and/or infection and a waiting period of several months . Materials and Methods: A retrospective analysis of more than 400 patients w ith an artificial sphincter revealed 23 who underwent de novo reimplantatio n between January 1983 and October 1998. All patients were men with a mean age of 66.5 years (range 16 to 88) and all had a urethral cuff. Reasons for cuff removal were erosion in 12 cases (52.2%), infection in 10 (43.5%) and intraoperative urethral injury in 1 (4.3%). Mean waiting period was 6.8 mo nths (range 1.5 to 32) between explantation and de novo reimplantation. Mea n followup was 32.6 months (range 1 to 108). Results: Of the 23 patients 20 (87%) had no mechanical or nonmechanical fai lures and 3 (13%) had nonmechanical failures, including 2 patients (8.7%) w hose cuff eroded into the urethra and 1 (4.3%) who had recurrent urinary in continence which was successfully treated with implantation of a tandem cuf f. There were no mechanical failures or infections in this group of patient s. Conclusions: Our study suggests that de novo artificial sphincter reimplant ation is an excellent treatment option. It is safe and associated with comp lication rates that are comparable to those of primary implantation.